Provider Demographics
NPI:1043405731
Name:KEBEDE, TEWABE GIRIMA (MD)
Entity Type:Individual
Prefix:MR
First Name:TEWABE
Middle Name:GIRIMA
Last Name:KEBEDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2340 E MEYER BLVD, BLDG 2
Mailing Address - Street 2:SUITE
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132
Mailing Address - Country:US
Mailing Address - Phone:816-276-1700
Mailing Address - Fax:816-276-1703
Practice Address - Street 1:2340 E MEYER BLVD, BLDG 2
Practice Address - Street 2:SUITE
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132
Practice Address - Country:US
Practice Address - Phone:816-276-1700
Practice Address - Fax:816-276-1703
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017038567207RN0300X
GA066958207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-119330OtherMEDICAL LICENSE NUMBER
KS201195680AMedicaid
TXP1775OtherMEDICAL LICENCE
GA066958OtherMEDICAL LICENCE